just curious if OMFS could essentially act as a Dental anesthesiologist for another GP, providing in office sedations for GPs or other specialists?
can an OMFS provide IV sedation for other dentists?
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Why would an OMFS ever do this?
Lets say you have a GP friend who is doing extensive dental work on an anxious pt, there is no DA in town, and just for the sake of helping this patient who otherwise will not receive care, you agree to provide sedation. Why is this totally out of the question? Lol
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must be a really, really good friend haha. I guess this could theoretically happen, but I just don't think it really ever would.
You would just keep contacting anesthesia groups till you could find one that is available or refer him to another place
honestly im mainly just coming at this from a perspective of providing care to patients who would have to go to an OR to get work done, because of lack of access to dental anesthesiologists. OR cost way more money and you have to jump through more loops. idk, i just feel like you could use your anesthesia skills to have a real impact on the community. Yes it will take time away from pulling thirds but youd be making a huge difference in someones life, and you wouldnt have to break your back to do it.
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I understand this is your perspective as a dental student. You may find that you will change your view once you get out in the field.
Also you are totally are busy enough making a difference in the life of your pts when practicing OS.
Also you are totally are busy enough making a difference in the life of your pts when practicing OS.
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Theoretically possible but practically it’s not going to happen. Rules vary state to state but typically both the surgeon and physical building both have to be certified by the state for anesthesia. That would mean having the dentist bring all their stuff to my practice which seems impractical. My malpractice specifically asks if I provide dedicated anesthesia and that will be another issue to overcome (they probably mean for young kids or running a vent in the office for another surgeon doing orthognathics or something). The patients that legitimately ‘need’ sedation for dental work 9/10 are legitimately crazy and nobody wants to deal with that. Did it once in residency as a favor and never again
Theoretically possible, but I’ve never heard of anyone ever doing this except in rare, one-off circumstances. And even then, usually as a personal favor. Just hire a traveling DA, get hospital privileges in your small town, or refer them to the big city to get their work done
Providing anesthesia for a dentist who doesn't understand sedation is terrifying.
I am an OMS, and my most scared moments are when I am doing the anesthesia and someone else is working in the mouth. There are so many things that make dentistry different than OMS procedures:
1) dentists use a lot more water
2) dentists generally work sitting, and the patient is leaned back - causing more water to go to the back of the throat
3) dentists just don't know.
4) dental work requires a completely still patient. As an OMS, my patients move a bit, and I'm okay with that.
5) dental assistants just don't know.
The type of anesthesia OMS are trained to do (vastly open airway), is not akin to operating room anesthesia (mostly intubated, protected and secured airway). We are trained for short cases, on healthy patients, with good local and minimal water. We are not a substitute for an operating room.
I would not put my license, or the safety of patients at risk in this regard. There's a more useful place for me in this world.
I am an OMS, and my most scared moments are when I am doing the anesthesia and someone else is working in the mouth. There are so many things that make dentistry different than OMS procedures:
1) dentists use a lot more water
2) dentists generally work sitting, and the patient is leaned back - causing more water to go to the back of the throat
3) dentists just don't know.
4) dental work requires a completely still patient. As an OMS, my patients move a bit, and I'm okay with that.
5) dental assistants just don't know.
The type of anesthesia OMS are trained to do (vastly open airway), is not akin to operating room anesthesia (mostly intubated, protected and secured airway). We are trained for short cases, on healthy patients, with good local and minimal water. We are not a substitute for an operating room.
I would not put my license, or the safety of patients at risk in this regard. There's a more useful place for me in this world.
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It seems that Jumpman26's underlying point is: There is a group of patients who need a service (advanced anesthesia services for restorative dentistry), and what is the best way to provide it? Good for him for recognizing this. My message to him is that it is possible, but there are a lot of things to consider.
If I remember, most restorative procedures benefit having a rubber dam for moisture control (except cementing a crown). I don't believe this is safe without full general anesthesia and an intubated airway. With "sedation" you can get into the excitement stage, with the attendant movement and airway problems. Jumpman26 will discover this during the anesthesia rotation in his OMS residency. Rubber dams get in the way of any airway manipulation, pharyngeal suctioning, etc. Moreover, you cannot mask ventilate with a rubber dam in place.
I have some OMS colleagues who intubate most cases in their clinics, but then they would have to stay with the patient. It does not make financial sense for an OMS to do this. They would be better off having a CRNA coming in to do that.
I have done quite a few combined cases at the hospital with the patient asleep and intubated. A general dentist performs restorative dentistry and then I perform dento-alveolar surgery. I do the admission, orders, etc. But those dentists must obtain and maintain hospital privileges, which can be a nuisance. Once I had a case that was cancelled just before surgery because there were no ICU beds that morning, and the patient might have needed one postoperatively. That patient had to wait a few months to reschedule. The dentist and I lost an entire day of production. Fortunately, he still maintains his privileges and is committed to serving our community this way.
For any anesthesia service outside the hospital/surgery center, my state mandates (and rightly so) that the facility be certified by the state dental board, so I would never go to someone else's dental clinic to provide anesthesia care.
Then, there is an issue of what type of equipment do you have in your OMS clinic. Do you have a dental micro-cart for a high speed hand-piece, high speed suctions, etc. Most OMS practices do not. Years ago, I put a dental micro-cart in one of my ORs. It was expensive to do, and it has not paid for itself.
I have done only 4-to-6 of these cases in the 23 years that I have had my own practice. These patients were asleep, but none were intubated, and I was right there the entire time. I own the airway. One case was for a periodontist to come in and do scaling and root planing on a patient with a severe gag reflex. The others were for severe dental phobics or developmentally-delayed adult patients. One of these was one for obtaining dental radiographs (for an eventual trip to the OR), and the others were for cementing crowns on patients who had had the crown preps done at the hospital. It is all copacetic and safe.
The bottom line is that it takes a lot of time, effort, and expense to create this service and keep it safe.
If I remember, most restorative procedures benefit having a rubber dam for moisture control (except cementing a crown). I don't believe this is safe without full general anesthesia and an intubated airway. With "sedation" you can get into the excitement stage, with the attendant movement and airway problems. Jumpman26 will discover this during the anesthesia rotation in his OMS residency. Rubber dams get in the way of any airway manipulation, pharyngeal suctioning, etc. Moreover, you cannot mask ventilate with a rubber dam in place.
I have some OMS colleagues who intubate most cases in their clinics, but then they would have to stay with the patient. It does not make financial sense for an OMS to do this. They would be better off having a CRNA coming in to do that.
I have done quite a few combined cases at the hospital with the patient asleep and intubated. A general dentist performs restorative dentistry and then I perform dento-alveolar surgery. I do the admission, orders, etc. But those dentists must obtain and maintain hospital privileges, which can be a nuisance. Once I had a case that was cancelled just before surgery because there were no ICU beds that morning, and the patient might have needed one postoperatively. That patient had to wait a few months to reschedule. The dentist and I lost an entire day of production. Fortunately, he still maintains his privileges and is committed to serving our community this way.
For any anesthesia service outside the hospital/surgery center, my state mandates (and rightly so) that the facility be certified by the state dental board, so I would never go to someone else's dental clinic to provide anesthesia care.
Then, there is an issue of what type of equipment do you have in your OMS clinic. Do you have a dental micro-cart for a high speed hand-piece, high speed suctions, etc. Most OMS practices do not. Years ago, I put a dental micro-cart in one of my ORs. It was expensive to do, and it has not paid for itself.
I have done only 4-to-6 of these cases in the 23 years that I have had my own practice. These patients were asleep, but none were intubated, and I was right there the entire time. I own the airway. One case was for a periodontist to come in and do scaling and root planing on a patient with a severe gag reflex. The others were for severe dental phobics or developmentally-delayed adult patients. One of these was one for obtaining dental radiographs (for an eventual trip to the OR), and the others were for cementing crowns on patients who had had the crown preps done at the hospital. It is all copacetic and safe.
The bottom line is that it takes a lot of time, effort, and expense to create this service and keep it safe.
Serious question, what were you doing that “might” have required an ICU postop? No offense to general dentists, but if I was doing something that might need ICU postop, there’s zero chance I’d invite someone in to do fillings. The one single scenario I can imagine would be a fibula reconstruction with immediate implants and immediate loading. Just curious what the case was
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It was several years ago, but I believe that the patient was about 30 years old, with multiple decayed teeth that were restorable, and others that were not. His medical history included a significant congitive and motor deficit, as well as a tracheostomy. We were going to change out the trach for a cuffed tube so that Anesthesia could could connect to it. Sometimes those patients need to stay overnight, and in our hospital, that would mean an ICU admission. There were no beds in the ICU. Had he had issues requiring an overnight stay, he would have had to have been transported to a larger institution an hour and a half away. The anesthesiologist and I agreed that we should delay his procedure due to this census issue.
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Every hospital is different. Some will have any OSA patient getting any facial surgery go to the ICU. Some will have all double jaws go to the ICU. Most large space infections with airway concerns go (but probably wouldn’t do routine dental with that)
That makes total sense. Fair enough
That’s what I’m saying though, there’s no chance I’d be doing a joint case with dental during a double jaw, space infection, or any significant facial surgery.
I get what OMS Doc is saying, some hospitals are terrified of trached patients on the floor. That scenario actually kinda makes sense
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There were some clutch times in residency where we would piggyback on other services taking sick as **** patients to the OR and we would do our thing while the primary service did all the management/paperwork. Different situation but fond memories
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With all due respect, I would not say that the hospital with which I have privileges is terrified of patients with tracheostomies on the floor...it is not. This hospital is owned and staffed by the best medical center in the world, so there is nothing they have not seen. The issue is whether these trach patients might need mechanical ventilation postoperatively. For that, they need an ICU. Hence, the anesthesiologist and I agreed to defer the case.
This raises the issue of "best practices", and this is an issue with which I agree completely. I know of no institution where tracheostomy patients have mechanical ventilation "on the floor." If you know of any, let me know.
This is a thread about whether an oral surgeon would sedate patients for a general dentist performing general dentistry. I have listed above some cases where I have. I have only done these because I know what is being done is safe. More complex dental cases need to be done with a secured (intubated) airway. If any oral surgeon wants to do that, they certainly will provide the best care, because that is what we do.
My wife and I have 7 children, and one son has special needs. He would never sit through a bridge prep with local anesthesia only. If he needed this done, it would be done at our hospital, with the best anesthesia service in the world performing the anesthetic, with an intubated, secure airway, and with my general dental colleague performing his dentistry. He is my son's dentist.
This raises the issue of "best practices", and this is an issue with which I agree completely. I know of no institution where tracheostomy patients have mechanical ventilation "on the floor." If you know of any, let me know.
This is a thread about whether an oral surgeon would sedate patients for a general dentist performing general dentistry. I have listed above some cases where I have. I have only done these because I know what is being done is safe. More complex dental cases need to be done with a secured (intubated) airway. If any oral surgeon wants to do that, they certainly will provide the best care, because that is what we do.
My wife and I have 7 children, and one son has special needs. He would never sit through a bridge prep with local anesthesia only. If he needed this done, it would be done at our hospital, with the best anesthesia service in the world performing the anesthetic, with an intubated, secure airway, and with my general dental colleague performing his dentistry. He is my son's dentist.
